How is shingles diagnosed. What are the treatment options for shingles. What lifestyle remedies can help manage shingles symptoms. How should patients prepare for a doctor’s appointment about shingles. What questions might a doctor ask about shingles symptoms.

Understanding Shingles: Causes, Symptoms, and Diagnosis

Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, which initially causes chickenpox. This condition typically manifests as a painful rash on one side of the body or face.

How do doctors diagnose shingles. Typically, a healthcare professional can diagnose shingles based on the following criteria:

• A history of pain localized to one side of the body
• The presence of a characteristic rash and blisters
• In some cases, a tissue scraping or culture of the blisters for laboratory examination

Can shingles occur more than once. While most people experience shingles only once in their lifetime, it is possible to develop the condition two or more times.

Famciclovir and Other Antiviral Medications for Shingles Treatment

While there is no cure for shingles, prompt treatment with prescription antiviral drugs can accelerate healing and reduce the risk of complications. Famciclovir is one of the primary medications used in the treatment of shingles.

What are the main antiviral medications prescribed for shingles. The most commonly prescribed antiviral drugs include:

• Famciclovir
• Acyclovir (Zovirax)
• Valacyclovir (Valtrex)

How does Famciclovir work in treating shingles. Famciclovir is an antiviral medication that works by stopping the growth and spread of the varicella-zoster virus. It helps to reduce the severity and duration of the shingles outbreak, as well as minimize the risk of post-herpetic neuralgia, a common complication of shingles characterized by persistent pain.

Managing Shingles Pain: Additional Treatment Options

Shingles can cause severe pain, and healthcare providers may prescribe additional medications to help manage this discomfort. These may include:

• Capsaicin topical patch (Qutenza)
• Anticonvulsants, such as gabapentin (Neurontin)
• Tricyclic antidepressants, like amitriptyline
• Numbing agents (e.g., lidocaine) in various forms such as creams, gels, sprays, or skin patches
• Narcotic medications, such as codeine
• Injections containing corticosteroids and local anesthetics

How long does a typical shingles outbreak last. Generally, shingles lasts between two and six weeks. However, the duration can vary depending on individual factors and the effectiveness of treatment.

Lifestyle and Home Remedies for Shingles Symptom Relief

In addition to medical treatments, several home remedies can help alleviate the discomfort associated with shingles:

1. Cool baths or cool, wet compresses applied to blisters to relieve itching and pain
2. Stress reduction techniques, as stress can exacerbate symptoms and prolong recovery
3. Adequate rest and relaxation to support the body’s healing process
4. Loose, comfortable clothing to avoid irritating the affected skin
5. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, to help manage pain and discomfort

Are there any dietary recommendations for managing shingles. While there’s no specific diet for shingles, consuming a balanced, nutrient-rich diet can support overall immune function and potentially aid in recovery. Foods high in vitamins A, C, and E, as well as B-complex vitamins, may be particularly beneficial.

Preparing for Your Doctor’s Appointment: What to Expect

When preparing for a medical appointment regarding shingles, it’s helpful to gather relevant information and prepare questions in advance. This preparation can ensure you make the most of your time with the healthcare provider.

Information to Gather Before Your Appointment

• A detailed description of your symptoms
• Your medical history, including past and present conditions
• Family medical history, particularly regarding parents and siblings
• A list of all medications, vitamins, and dietary supplements you’re currently taking

Questions to Ask Your Healthcare Provider

Consider preparing a list of questions, prioritized from most to least important. Some key questions to consider include:

1. What’s the most likely cause of my symptoms?
2. How long can I expect to have symptoms?
3. What caused me to develop shingles? Is recurrence possible?
4. What treatment do you recommend, and how quickly should I start to feel better?
5. What should I do if my symptoms don’t improve?
6. Are there any brochures or reliable websites you recommend for more information?

Should patients bring someone along to their shingles appointment. It can be beneficial to bring a trusted friend or family member to your appointment. They can help remember important information, take notes, and provide support during the visit.

Understanding Your Doctor’s Approach: Potential Questions and Examinations

During your appointment, your healthcare provider will likely examine your rash and ask several questions to gain a comprehensive understanding of your condition. Some questions you might encounter include:

• When did your symptoms begin?
• Does anything make your symptoms better or worse?
• Do you know if you’ve ever had chickenpox?
• Have you experienced any fever or other systemic symptoms?
• Are you experiencing any vision changes or facial weakness?

What type of physical examination will the doctor perform. The healthcare provider will typically conduct a thorough examination of the affected area, looking for the characteristic rash and blisters associated with shingles. They may also check for signs of complications, such as involvement of the eyes or ears.

Shingles Vaccination: Prevention and Recommendations

Vaccination plays a crucial role in preventing shingles and its complications. The Centers for Disease Control and Prevention (CDC) recommends vaccination for certain groups to reduce the risk of developing shingles.

Current Shingles Vaccine Recommendations

Who should consider getting the shingles vaccine. The CDC recommends the following:

• Adults 50 years and older should get two doses of the Shingrix vaccine
• Adults 19 years and older who have weakened immune systems should also receive two doses of Shingrix
• The vaccine is recommended even for those who have previously had shingles or received the older Zostavax vaccine

How effective is the Shingrix vaccine in preventing shingles. Studies have shown that Shingrix is more than 90% effective in preventing shingles and post-herpetic neuralgia in adults 50 years and older. Its effectiveness remains high across all age groups, including those over 70 years old.

Long-term Management and Follow-up Care for Shingles Patients

While most cases of shingles resolve within a few weeks, some patients may experience long-term effects or complications that require ongoing management and follow-up care.

Potential Long-term Complications

What are the possible long-term effects of shingles. Some patients may experience:

• Post-herpetic neuralgia (PHN): Persistent pain in the area affected by shingles
• Vision problems: If shingles affects the eye area
• Skin infections: Secondary bacterial infections of the rash
• Nerve damage: In rare cases, leading to weakness or paralysis

How is post-herpetic neuralgia managed. Treatment for PHN may include:

1. Topical treatments such as lidocaine patches or capsaicin cream
2. Oral medications like gabapentin, pregabalin, or tricyclic antidepressants
3. Pain management techniques, including transcutaneous electrical nerve stimulation (TENS)
4. Psychological support to cope with chronic pain

When should patients follow up with their healthcare provider after a shingles outbreak. It’s generally recommended to schedule a follow-up appointment 2-4 weeks after the initial diagnosis, or sooner if symptoms worsen or new concerns arise. Patients experiencing persistent pain or other complications may require more frequent follow-ups.

Shingles in Special Populations: Considerations and Precautions

While shingles can affect anyone who has had chickenpox, certain populations may require special considerations in terms of prevention, diagnosis, and treatment.

Shingles in Immunocompromised Individuals

Why are immunocompromised individuals at higher risk for shingles. People with weakened immune systems, such as those undergoing cancer treatment, taking immunosuppressive medications, or living with HIV/AIDS, are more susceptible to shingles reactivation and may experience more severe symptoms.

What precautions should immunocompromised individuals take regarding shingles. These may include:

• Regular check-ups with healthcare providers
• Prompt reporting of any suspicious rashes or pain
• Discussing vaccination options with their healthcare team
• Taking extra care to avoid exposure to chickenpox if they’ve never had it

Shingles During Pregnancy

Can pregnant women develop shingles. Yes, pregnant women can develop shingles, although it’s relatively rare. The risk to the developing fetus is generally low, especially if the mother has had chickenpox before pregnancy.

How is shingles treated during pregnancy. Treatment approaches may include:

1. Antiviral medications deemed safe for use during pregnancy
2. Close monitoring by both an obstetrician and a dermatologist
3. Pain management strategies that are safe for both mother and fetus
4. Extra precautions to prevent transmission of the virus to the newborn during delivery

Are there any specific risks associated with shingles during pregnancy. While the overall risk is low, potential concerns include:

• Premature labor if the mother develops severe symptoms
• Potential transmission of the virus to the newborn if the outbreak occurs near the time of delivery
• Limitations on certain treatments that may not be safe during pregnancy

By understanding these special considerations, healthcare providers can tailor their approach to ensure the best possible outcomes for all patients affected by shingles, regardless of their individual circumstances or health status.

Shingles – Diagnosis and treatment

Diagnosis

Shingles is usually diagnosed based on the history of pain on one side of your body, along with the telltale rash and blisters. Your doctor may also take a tissue scraping or culture of the blisters for examination in the laboratory.

Treatment

There’s no cure for shingles, but prompt treatment with prescription antiviral drugs can speed healing and reduce your risk of complications. These medications include:

• Acyclovir (Zovirax)
• Famciclovir
• Valacyclovir (Valtrex)

Shingles can cause severe pain, so your doctor also may prescribe:

• Capsaicin topical patch (Qutenza)
• Anticonvulsants, such as gabapentin (Neurontin)
• Tricyclic antidepressants, such as amitriptyline
• Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch
• Medications that contain narcotics, such as codeine
• An injection including corticosteroids and local anesthetics

Shingles generally lasts between two and six weeks. Most people get shingles only once, but it is possible to get it two or more times.

Lifestyle and home remedies

Taking a cool bath or using cool, wet compresses on your blisters may help relieve the itching and pain. And, if possible, try to reduce the amount of stress in your life.

Preparing for your appointment

Some people have such mild symptoms of shingles that they don’t seek medical treatment. At the other extreme, severe symptoms may result in a visit to the emergency room.

What you can do

You may want to write a list that includes:

• A detailed description of your symptoms
• Information about your medical problems, past and present
• Information about the medical problems of your parents or siblings
• All the medications, vitamins and dietary supplements you take

Preparing a list of questions ahead of time will help you make the most of your limited time with your doctor. List your questions from most important to least important in case time runs out. For shingles, some basic questions to ask your doctor include:

• What’s the most likely cause of my symptoms?
• How long will I have symptoms?
• What caused me to develop shingles? Can I get it again?
• What treatment do you recommend? How quickly will I start to feel better?
• What if my symptoms don’t improve?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask any additional questions that occur to you during your appointment.

What to expect from your doctor

Your doctor will examine your rash and may ask some of the following questions:

• When did your symptoms begin?
• Does anything make them better or worse?
• Do you know if you’ve ever had chickenpox?

Oct. 06, 2020

Show references

1. Shingles: Hope through research. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Shingles-Hope-Through-Research. Accessed May 9, 2017.
2. Yun H, et al. Longterm effectiveness of herpes zoster vaccine among patients with autoimmune and inflammatory diseases. Journal of Rheumatology. In press. Accessed May 9, 2017.
3. Ferri FF. Herpes zoster. In: Ferri’s Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed May 9, 2017.
4. Bennett JE, et al., eds. Chickenpox and herpes zoster (varicella-zoster virus). In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. https://www.clinicalkey.com. Accessed May 9, 2017.
5. Shingles: Clinical overview. Centers for Disease Control and Prevention. http://www. cdc.gov/shingles/hcp/clinical-overview.html. Accessed May 9, 2017.
6. Longo DL, et al., eds. Varicella-zoster virus infections. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed May 9, 2017.
7. Albrecht MA, et al. Vaccination for the prevention of shingles (herpes zoster). https://www.uptodate.com/contents/search. Accessed Sept. 10, 2020.
8. Zostavax (zoster vaccine live) recommendations. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/shingles/hcp/zostavax/recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fvpd%2Fshingles%2Fhcp%2Frecommendations.html. Accessed Sept. 10, 2020.
9. Shingrix recommendations. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html. Accessed Sept. 10, 2020.
10. AskMayoExpert. Herpes zoster (shingles). Mayo Clinic; 2019.

Related

Show more related content

Shingles | NHS inform

There is no cure for shingles, but treatment can help ease your symptoms until the condition improves. In many cases, shingles gets better within around two to four weeks.

However, it’s still important to see your GP or pharmacist as soon as possible if you recognise the symptoms of shingles, as early treatment may help reduce the severity of the condition and the risk of potential complications.

Self-care

If you develop the shingles rash, there are a number of things you can do to help relieve your symptoms, such as:

• keeping the rash as clean and dry as possible – this will reduce the risk of the rash becoming infected with bacteria
• wearing loose-fitting clothing – this may help you feel more comfortable
• not using topical (rub-on) antibiotics or adhesive dressings such as plasters – this can slow down the healing process
• using a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters – this avoids passing the virus to anyone else

Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.

If you have any weeping blisters, you can use a cool compress (a cloth or a flannel cooled with tap water) several times a day to help soothe the skin and keep blisters clean.

It’s important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing. Don’t share any cloths, towels or flannels if you have the shingles rash. 

Antiviral medication

As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting 7 to 10 days. Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.

These medications cannot kill the shingles virus, but can help stop it multiplying. This may:

• reduce the severity of your shingles
• reduce how long your shingles lasts
• prevent complications of shingles, such as postherpetic neuralgia (although the evidence for this is uncertain)

Antiviral medicines are most effective when taken within 72 hours of your rash appearing, although they may be started up to a week after your rash appears if you are at risk of severe shingles or developing complications.

Side effects of antiviral medication are very uncommon, but can include:

Who may be prescribed antiviral medication?

If you are over 50 years of age and have symptoms of shingles, it is likely you will be prescribed an antiviral medication.

You may also be prescribed antiviral medication if you have:

• shingles that affects one of your eyes
• a weakened immune system
• moderate to severe pain
• a moderate to severe rash

Pregnancy and antiviral medication

If you are pregnant and have shingles, it is likely your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles will not harm your unborn baby.

If you are under 50 years of age, you are at less risk of developing complications from shingles anyway, so you may not need antiviral medication.

Children and antiviral medication

Antiviral medication is not usually necessary for otherwise healthy children because they usually only experience mild symptoms of shingles and have a small risk of developing complications.

However, if your child has a weakened immune system, they may need to be admitted to hospital to receive antiviral medication directly into a vein (intravenously).

Painkilling medication

To ease the pain caused by shingles, your GP or pharmacist may recommend painkilling medication. Some of the main medications used to relieve pain associated with shingles are described below.

Paracetamol

The most commonly used painkiller is paracetamol, which is available without a prescription. Always read the manufacturer’s instructions to make sure the medicine is suitable and you are taking the correct dose.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are an alternative type of painkilling medicine also available without a prescription.

However, NSAIDs may not be suitable if you:

• have stomach, liver or kidney problems, such as a stomach ulcer, or had them in the past
• have asthma
• are pregnant or breastfeeding

Ask your GP or pharmacist if you are unsure about whether you should take NSAIDs.  

Opioids

For more severe pain, your GP may prescribe an opioid, such as codeine. This is a stronger type of painkiller sometimes prescribed alongside paracetamol.

Occasionally, your GP may consider seeking specialist advice before prescribing an even stronger opioid, such as morphine.

Antidepressants

If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine. These medications are commonly used to treat depression, but they have also proven to be useful in relieving nerve pain, such as the pain associated with shingles.

The antidepressants most often used to treat shingles pain are known as tricyclic antidepressants (TCAs). Examples of TCAs most commonly prescribed for people with shingles are amitriptyline, imipramine and nortriptyline.

Side effects of TCAs can include:

• constipation
• difficulty urinating
• blurred vision
• dry mouth
• weight gain
• drowsiness

If you have shingles, you will usually be prescribed a much lower dose of TCAs than if you were being treated for depression. This will usually be a tablet to take at night. Your dose may be increased until your pain settles down.

It may take several weeks before you start to feel the antidepressants working, although this is not always the case.

Anticonvulsants

Anticonvulsants are most commonly used to control seizures (fits) caused by epilepsy, but they are also useful in relieving nerve pain.

Gabapentin is the most commonly prescribed anticonvulsants for shingles pain.

Side effects of these medications can include:

• dizziness
• drowsiness
• increased appetite
• weight gain
• feeling sick
• vomiting

As with antidepressants, you may need to take anticonvulsants for several weeks before you notice it working.

If your pain does not improve, your dose may be gradually increased until your symptoms are effectively managed.

Management of Herpes Zoster (Shingles) and Postherpetic Neuralgia

SETH JOHN STANKUS, MAJ, MC, USA, MICHAEL DLUGOPOLSKI, MAJ, MC, USA, and DEBORAH PACKER, MAJ, MC, USA, Eisenhower Army Medical Center, Fort Gordon, Georgia

Am Fam Physician.  2000 Apr 15;61(8):2437-2444.

 
Patient information: See related handout on shingles, written by the authors of this article.

Herpes zoster (commonly referred to as “shingles”) and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Herpes zoster is usually treated with orally administered acyclovir. Other antiviral medications include famciclovir and valacyclovir. The antiviral medications are most effective when started within 72 hours after the onset of the rash. The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients.

Herpes zoster results from reactivation of the varicella-zoster virus. Unlike varicella (chickenpox), herpes zoster is a sporadic disease with an estimated lifetime incidence of 10 to 20 percent. The incidence of herpes zoster increases sharply with advancing age, roughly doubling in each decade past the age of 50 years. Herpes zoster is uncommon in persons less than 15 years old. In a recent study,1 patients more than 55 years of age accounted for more than 30 percent of herpes zoster cases despite representing only 8 percent of the study population. In this same study, children less than 14 years old represented only 5 percent of herpes zoster cases.

The normal age-related decrease in cell-mediated immunity is thought to account for the increased incidence of varicella-zoster virus reactivation. Patients with disease states that affect cell-mediated immunity, such as human immunodeficiency virus (HIV) infection and certain malignancies, are also at increased risk. Chronic corticosteroid use, chemotherapy and radiation therapy may increase the risk of developing herpes zoster.

The incidence of herpes zoster is up to 15 times higher in HIV-infected patients than in uninfected persons, and as many as 25 percent of patients with Hodgkin’s lymphoma develop herpes zoster. 2,3 The occurrence of herpes zoster in HIV-infected patients does not appear to increase the risk of acquired immunodeficiency syndrome (AIDS) and is less dependent on the CD4 count than AIDS-related opportunistic infections.2 There is no evidence that herpes zoster heralds the onset of an underlying malignancy.3

Race may influence susceptibility to herpes zoster. Blacks are one fourth as likely as whites to develop this condition.4 Although herpes zoster is not as contagious as the primary varicella infection, persons with reactivated infection can transmit varicella-zoster virus to nonimmune contacts. Household transmission rates have been noted to be approximately 15 percent.5

About 20 percent of patients with herpes zoster develop postherpetic neuralgia. The most established risk factor is age; this complication occurs nearly 15 times more often in patients more than 50 years of age. Other possible risk factors for the development of post-herpetic neuralgia are ophthalmic zoster, a history of prodromal pain before the appearance of skin lesions and an immunocompromised state. 6

Pathophysiology

Varicella-zoster virus is a highly contagious DNA virus. Varicella represents the primary infection in the nonimmune or incompletely immune person. During the primary infection, the virus gains entry into the sensory dorsal root ganglia. How the virus enters the sensory dorsal root ganglia and whether it resides in neurons or supporting cells are not completely understood. The varicella-zoster virus genome has been identified in the trigeminal ganglia of nearly all seropositive patients.7

The virus remains latent for decades because of varicella-zoster virus–specific cell-mediated immunity acquired during the primary infection, as well as endogenous and exogenous boosting of the immune system periodically throughout life.8 Reactivation of the virus occurs following a decrease in virus-specific cell-mediated immunity. The reactivated virus travels down the sensory nerve and is the cause for the dermatomal distribution of pain and skin lesions.

The pathophysiology of postherpetic neuralgia remains unclear. However, pathologic studies have demonstrated damage to the sensory nerves, the sensory dorsal root ganglia and the dorsal horns of the spinal cord in patients with this condition.9

Clinical Presentation

Herpes zoster typically presents with a prodrome consisting of hyperesthesia, paresthesias, burning dysesthesias or pruritus along the affected dermatome(s). The prodrome generally lasts one to two days but may precede the appearance of skin lesions by up to three weeks.

During the prodromal phase, herpes zoster may be misdiagnosed as cardiac disease, pleurisy, a herniated nucleus pulposus or various gastrointestinal or gynecologic disorders. Some patients may have prodromal symptoms without developing the characteristic rash. This situation, known as “zoster sine herpete,” may further complicate the eventual diagnosis.

The prodromal phase is followed by development of the characteristic skin lesions of herpes zoster. The skin lesions begin as a maculopapular rash that follows a dermatomal distribution, commonly referred to as a “belt-like pattern. ” The maculopapular rash evolves into vesicles with an erythematous base (Figure 1). The vesicles are generally painful, and their development is often associated with the occurrence of anxiety and flu-like symptoms.

View/Print Figure

FIGURE 1.

Typical dermatomal rash with hemorrhagic vesicles on the trunk of a patient with herpes zoster.

FIGURE 1.

Typical dermatomal rash with hemorrhagic vesicles on the trunk of a patient with herpes zoster.

Pain is the most common complaint for which patients with herpes zoster seek medical care. The pain may be described as “burning” or “stinging” and is generally unrelenting. Indeed, patients may have insomnia because of the pain.10 Although any vertebral dermatome may be involved, T5 and T6 are most commonly affected. The most frequently involved cranial nerve dermatome is the ophthalmic division of the trigeminal nerve. Twenty or more lesions outside the affected dermatome reflect generalized viremia. Of these patients, approximately one half manifest other neurologic or visceral involvement, and as many as one in seven with viremia may die.

The vesicles eventually become hemorrhagic or turbid and crust over within seven to 10 days. As the crusts fall off, patients are generally left with scarring and pigmentary changes.

Ocular complications occur in approximately one half of patients with involvement of the ophthalmic division of the trigeminal nerve. These complications include mucopurulent conjunctivitis, episcleritis, keratitis and anterior uveitis. Cranial nerve palsies of the third, fourth and sixth cranial nerves may occur, affecting extraocular motility.

The most common chronic complication of herpes zoster is postherpetic neuralgia. Pain that persists for longer than one to three months after resolution of the rash is generally accepted as the sign of postherpetic neuralgia.11 Affected patients usually report constant burning, lancinating pain that may be radicular in nature. Patients may also complain of pain in response to non-noxious stimuli. Even the slightest pressure from clothing, bedsheets or wind may elicit pain.

Postherpetic neuralgia is generally a self-limited disease. Symptoms tend to abate over time. Less than one quarter of patients still experience pain at six months after the herpes zoster eruption, and fewer than one in 20 has pain at one year.

Treatment of Herpes Zoster

The treatment of herpes zoster has three major objectives: (1) treatment of the acute viral infection, (2) treatment of the acute pain associated with herpes zoster and (3) prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.

ANTIVIRAL AGENTS

Antiviral agents have been shown to decrease the duration of herpes zoster rash and the severity of pain associated with the rash.12 However, these benefits have only been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash. Antiviral agents may be beneficial as long as new lesions are actively being formed, but they are unlikely to be helpful after lesions have crusted.

The effectiveness of antiviral agents in preventing postherpetic neuralgia is more controversial. Numerous studies evaluating this issue have been conducted, but the results have been variable. Based on the findings of multiple studies, acylovir (Zovirax) therapy appears to produce a moderate reduction in the development of postherpetic neuralgia.13 Other antiviral agents, specifically valacyclovir (Valtrex) and famciclovir (Famvir), appear to be at least as effective as acyclovir.

Acyclovir, the prototype antiviral drug, is a DNA polymerase inhibitor. Acyclovir may be given orally or intravenously. Major drawbacks of orally administered acyclovir include its lower bioavailability compared with other agents and its dosing frequency (five times daily). Intravenously administered acyclovir is generally used only in patients who are severely immunocompromised or who are unable to take medications orally.

Valacyclovir, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia.14 Valacyclovir is also more bioavailable than acyclovir, and oral administration produces blood drug levels comparable to the intravenous administration of acyclovir.

Famciclovir is also a DNA polymerase inhibitor. The advantages of famciclovir are its dosing schedule (three times daily), its longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir.

The choice of which antiviral agent to use is individualized. Dosing schedule and cost may be considerations. The recommended dosages for acyclovir, famciclovir and valacyclovir are provided in Table 1. All three antiviral agents are generally well tolerated. The most common adverse effects are nausea, headache, vomiting, dizziness and abdominal pain.

View/Print Table

TABLE 1

Treatment Options for Herpes Zoster

TABLE 1

Treatment Options for Herpes Zoster

CORTICOSTEROIDS

Orally administered corticosteroids are commonly used in the treatment of herpes zoster, even though clinical trials have shown variable results. Prednisone used in conjunction with acyclovir has been shown to reduce the pain associated with herpes zoster.15 The likely mechanism involves decreasing the degree of neuritis caused by active infection and, possibly, decreasing residual damage to affected nerves.

Some studies designed to evaluate the effectiveness of prednisone therapy in preventing postherpetic neuralgia have shown decreased pain at three and 12 months.16,17 Other studies have demonstrated no benefit.15,18

If the use of orally administered prednisone is not contraindicated, adjunctive treatment with this agent is justified on the basis of its effects in reducing pain, despite questionable evidence for its benefits in decreasing the incidence of postherpetic neuralgia. Given the theoretic risk of immunosuppression with corticosteroids, some investigators believe that these agents should be used only in patients more than 50 years of age because they are at greater risk of developing postherpetic neuralgia.15  The recommended dosage for prednisone is given in Table 1.

ANALGESICS

The pain associated with herpes zoster ranges from mild to excruciating. Patients with mild to moderate pain may respond to over-the-counter analgesics. Patients with more severe pain may require the addition of a narcotic medication. When analgesics are used, with or without a narcotic, a regular dosing schedule results in better pain control and less anxiety than “as-needed” dosing.

Lotions containing calamine (e.g., Caladryl) may be used on open lesions to reduce pain and pruritus. Once the lesions have crusted over, capsaicin cream (Zostrix) may be applied. Topically administered lidocaine (Xylocaine) and nerve blocks have also been reported to be effective in reducing pain.

OCULAR INVOLVEMENT

Ocular herpes zoster is treated with orally administered antiviral agents and corticosteroids, the same as involvement elsewhere. Although most patients with ocular herpes zoster improve without lasting sequelae, some may develop severe complications, including loss of vision. When herpes zoster involves the eyes, ophthalmologic consultation is usually recommended.

PREVENTIVE TREATMENT

The morbidity and mortality of herpes zoster could be reduced if a safe and effective preventive treatment were available. It is unusual for a patient to develop herpes zoster more than once, suggesting that the first reactivation of varicella-zoster virus usually provides future immunologic protection. Studies are currently being conducted to evaluate the efficacy of the varicella-zoster vaccine in preventing or modifying herpes zoster in the elderly.

Treatment of Postherpetic Neuralgia

Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Treatment is directed at pain control while waiting for the condition to resolve. Pain therapy may include multiple interventions, such as topical medications, over-the-counter analgesics, tricyclic antidepressants, anticonvulsants and a number of nonmedical modalities. Occasionally, narcotics may be required. Dosage recommendations are provided in Table 2.

View/Print Table

TABLE 2

Treatment Options for Postherpetic Neuralgia*

TABLE 2

Treatment Options for Postherpetic Neuralgia*

ANALGESICS

Capsaicin, an extract from hot chili peppers, is currently the only drug labeled by the U.S. Food and Drug Administration for the treatment of postherpetic neuralgia.19 Trials have shown this drug to be more efficacious than placebo but not necessarily more so than other conventional treatments.20

Substance P, a neuropeptide released from pain fibers in response to trauma, is also released when capsaicin is applied to the skin, producing a burning sensation. Analgesia occurs when substance P is depleted from the nerve fibers. To achieve this response, capsaicin cream must be applied to the affected area three to five times daily. Patients must be counseled about the need to apply capsaicin regularly for continued benefit. They also need to be counseled that their pain will likely increase during the first few days to a week after capsaicin therapy is initiated. Patients should wash their hands thoroughly after applying capsaicin cream in order to prevent inadvertent contact with other areas.

Patches containing lidocaine have also been used to treat postherpetic neuralgia. One study found that compared with no treatment, lidocaine patches reduced pain intensity, with minimal systemic absorption. Although lidocaine was efficacious in relieving pain, the effect was temporary, lasting only four to 12 hours with each application.21

Over-the-counter analgesics such as acetaminophen (e.g., Tylenol) and nonsteroidal anti-inflammatory drugs have not been shown to be highly effective in the treatment of post-herpetic neuralgia. However, these agents are often useful for potentiating the pain-relieving effects of narcotics in patients with severe pain. Because of the addictive properties of narcotics, their chronic use is discouraged except in the rare patient who does not adequately respond to other modalities.

TRICYCLIC ANTIDEPRESSANTS

Tricyclic antidepressants can be effective adjuncts in reducing the neuropathic pain of postherpetic neuralgia. These agents most likely lessen pain by inhibiting the reuptake of serotonin and norepinephrine neurotransmitters.22

Tricyclic antidepressants commonly used in the treatment of postherpetic neuralgia include amitriptyline (Elavil), nortriptyline (Pamelor), imipramine (Tofranil) and desipramine (Norpramin). These drugs are best tolerated when they are started in a low dosage and given at bedtime. The dosage is increased every two to four weeks to achieve an effective dose.

The tricyclic antidepressants share common side effects, such as sedation, dry mouth, postural hypotension, blurred vision and urinary retention. Nortriptyline and amitriptyline appear to have equal efficacy; however, nortriptyline tends to produce fewer anticholinergic effects and is therefore better tolerated. Treatment with tricyclic antidepressants can occasionally lead to cardiac conduction abnormalities or liver toxicity. The potential for these problems should be considered in elderly patients and patients with cardiac or liver disease.

Because tricyclic antidepressants do not act quickly, a clinical trial of at least three months is required to judge a patient’s response. The onset of pain relief using tricyclic antidepressants may be enhanced by beginning treatment early in the course of herpes zoster infection in conjunction with antiviral medications.20

ANTICONVULSANTS

Phenytoin (Dilantin), carbamazepine (Tegretol) and gabapentin (Neurontin) are often used to control neuropathic pain. A recent double-blind, placebo-controlled study showed gabapentin to be effective in treating the pain of postherpetic neuralgia, as well as the often associated sleep disturbance.23

The anticonvulsants appear to be equally effective, and drug selection often involves trial and error. Lack of response to one of these medications does not necessarily portend a poor response to another. The dosages required for analgesia are often lower than those used in the treatment of epilepsy.

Anticonvulsants are associated with a variety of side effects, including sedation, memory disturbances, electrolyte abnormalities, liver toxicity and thrombocytopenia. Side effects may be reduced or eliminated by initiating treatment in a low dosage, which can then be slowly titrated upward.

There are no specific contraindications to using anticonvulsants in combination with antidepressants or analgesics. However, the risk of side effects increases when multiple medications are used.

Effective treatment of postherpetic neuralgia often requires multiple treatment approaches. In addition to medications, modalities to consider include transcutaneous electric nerve stimulation (TENS), biofeedback and nerve blocks.

Final Comment

Herpes zoster and postherpetic neuralgia are relatively common conditions, primarily in elderly and immunocompromised patients. Although the diagnosis of the conditions is generally straightforward, treatment can be frustrating for the patient and physician. Approaches to management include treatment of the herpes zoster infection and associated pain, prevention of postherpetic neuralgia, and control of the neuropathic pain until the condition resolves. Primary treatment modalities include antiviral agents, corticosteroids, tricyclic antidepressants and anticonvulsants.

How to Diagnose and Treat Shingles

OK, it’s not deadly like cancer, or chronic like diabetes, or debilitating like multiple sclerosis. But trust us: Shingles is still an intensely painful illness you want to avoid. Fortunately, a breakthrough vaccine is making that possible. If you do get shingles though, early diagnosis is everything: The sooner you begin treatment, the less likely you are to experience a severe case with complications that can last long after the blistering rash has cleared up. We asked the experts how to spot—and treat—this challenging condition.

More Top Articles on Shingles

Shingles Diagnosis and Treatment

Frequently Asked Questions

Is there a cure for shingles?

There is no cure, but there are effective treatments that can lessen the severity of the illness, especially if you’re diagnosed early. Antiviral medications are the first-line treatment, and doctors may also prescribe the steroid prednisone and the anticonvulsant gabapentin in an effort to prevent PHN (postherpetic neuralgia), a painful, potentially chronic complication that results from nerve damage and occurs in about one in five people with shingles.

How early can shingles be diagnosed?

Believe it or not, many people can feel shingles before the rash even appears. This symptom is known as paresthesia, an itching, burning, or tingling sensation that you experience on one side of the body before the rash is even present. It happens because the virus hangs out in the nerves of your skin, becoming active there before triggering the telltale rash a few days later. If you are experiencing a painful sensation on one side of your body, even if you don’t see a rash, get things checked out.

Does the shingles vaccine have side effects?

There’s a good chance you’re not going to feel great for one to three days after, but the side effects are nothing compared to the unpleasantness of shingles. You might experience pain, redness, and swelling at the injection site; muscle pain; fatigue; headache; fever; or upset stomach. Sounds like a drag, but it will rev up your immune system so it’s primed to beat back shingles, which is exactly what you want.

Are there other complications beside PHN?

Yes, although rare. If shingles occur in or near your eyes, forehead, or nose it can lead to eye pain, glaucoma, or even permanent loss of vision. Shingles on or around your ears can cause Ramsay Hunt Syndrome, which leads to dizziness and balance problems, ringing in your ear (tinnitus), earaches, facial paralysis, and hearing loss. And shingles can spread into the brain or spinal cord, resulting in a stroke or meningitis.

What Is Shingles, Again?

Shingles is a painful rash that is caused by the same virus as chickenpox. If you were born before 1980, it’s highly likely that you had chickenpox when you were younger. The red, itchy rash is caused by the varicella zoster virus, and once it enters your body, it never leaves, even after you’ve recovered. Instead it takes up residence in the roots of your nerves and goes into hibernation. Decades later, the virus can “wake up” and cause shingles—medically known as herpes zoster when it makes this second appearance.

Given how common chickenpox was before a vaccine was developed for it 25 years ago, it’s easy to see why shingles is equally prevalent among the older population. In fact, one million adults develop shingles every year in the United States. Close to one in three people will get shingles in their lifetime, and that increases to 50% of people who live to age 85.

One of the biggest mysteries with shingles is what causes the virus to reactivate suddenly, after years of snoozing. While doctors are still exploring the reasons, a weakened immune system appears to be the primary culprit. To that end, along with exposure to chickenpox, risk factors for shingles include:

• Age: Anyone over age 50 is vulnerable because the immune system becomes less effective with age.

• Certain medical conditions: Having cancer, HIV, autoimmune disorders, or being an organ transplant recipient all weaken the immune system.

• Undergoing cancer treatment: Radiation and chemotherapy can lower your resistance to diseases and may trigger shingles.

• Stress: Chronic daily stress or a single, highly stressful event such as the death of a loved one, divorce, or job loss, causes the body to produce the stress hormone cortisol, which diminishes the effectiveness of the immune system. Physical stress may contribute, too: Shingles has been known to develop while the body is fighting another type of infection or after an injury that could irritate a nerve the virus calls home.

• Immunocompromising drugs: Taking long-term steroids (such as prednisone) or other medicines that can weaken the immune system and drugs designed to prevent rejection of transplanted organs can increase the risk of shingles.

• Serious physical injury: Physical trauma (which could be anything from a wound to a fracture) may be a risk factor, especially for shingles.

Usually shingles resolves in three to five weeks with treatment and no further complications. But about 20% of the time, it progresses to serious nerve damage and chronic pain in the area where the rash was that can last for months or even years. Nerve fibers that have been damaged by shingles can’t send messages from your skin to your brain as effectively, so they become exaggerated, causing chronic and even excruciating pain known as postherpetic neuralgia (PHN). A bit about PHN:

• The condition is defined as pain in the same area lasting more than three months after the acute shingles rash has healed.

• It is more likely to occur the older you are.

• People with weakened immune systems are more susceptible.

• It is more like to affect those who experienced a severe shingles rash and intense pain. PHN pain has been described as burning, stinging, jabbing, shooting, and sharp. You may also experience deep, throbbing, and aching pain.

• It can make you extremely sensitive to touch, so activities like getting dressed or trying to sleep can be difficult.

Often PHN pain will gradually go away within about a year, but it can persist much longer or come and go intermittently and can have serious repercussions: It can be so debilitating that it causes depression, anxiety, sleep deprivation, weight loss, and difficulty with daily activities.

Treatment will depend on the type of pain as well as the patient’s physical, neurological, and mental health. Treatment can be painkillers, anticonvulsants, steroids, or antidepressants. In some cases, electrodes may be placed over the pain area and a device called “transcutaneous electrical nerve stimulation” (TENS) is used to relieve symptoms. Similar to TENS, sometimes spinal cord or peripheral nerve stimulation might be required to relieve the pain.

Get the Full Story on Shingles

You Can Prevent Shingles

The good news is that you can avoid this misery entirely by getting a fairly new vaccine that’s proving to be highly effective. There has actually been a shingles vaccine since 2006, but the first incarnation, Zostavax, only prevented shingles in about 50% of people. Plus, Zostavax was made from live viruses so people with compromised immune systems couldn’t get it even though they are the ones most at risk for shingles.

The new vaccine, Shingrix, available since 2017, does not use live viruses in its formulation so it’s safer and has been found to be more than 90% effective. Shingrix is what’s known as an adjuvanted vaccine, meaning it has extra ingredients that help create a stronger immune response. A booster shot may be needed eventually, but experts currently estimate the vaccine provides protection for at least seven years. It’s available for adults age 50 and up and requires two doses given between two and six months apart.

On the slim chance you do get shingles after being vaccinated, the illness will be much milder and you will be less likely to develop PHN.

How Is Shingles Diagnosed?

So let’s say you read all that and you still haven’t gotten the shingles vaccine. And let’s say you wake up one morning feeling weird pain in parts of your back, and then before you know it, you see a rash forming. How will your doctor know if it’s shingles?

You needn’t worry about undergoing a lot of poking and prodding—tests are seldom needed to diagnose this illness. Most doctors can do it by sight since there are some obvious clues and a very specific pattern of symptoms. (In some cases, a blister sample might be taken for examination under a microscope to confirm the diagnosis if there’s any question, but it’s usually not necessary.) You can also do a preliminary telehealth appointment if you do not want to visit your healthcare provider during the continuing COVID-19 crisis.

One reason it’s easy to recognize is that shingles is aptly named: The wide stripe-shaped rash that occurs literally resembles a shingle on a house. Another red flag is the location. Shingles will only develop on one side of the body—most likely the torso—in the same area as the nerve that’s playing host to the virus. Here’s how that works:

• The patch of skin where the rash appears is known as a dermatome—an area that is supplied by a single spinal nerve whose job is to send sensations like pain or itching to the brain.

• The body has 31 such spinal nerves between the neck and the tailbone, each of which originates at one side of the spine and runs horizontally around your torso to the front of the body, where it stops.

• These spinal nerves never cross the midsection of your body, so neither does the rash. (You would never get a shingles rash that starts on the left of your waist and spreads across to the right side—it is always going to stop by the mid-point of your abdomen or back.)

The next big clue is the very specific pattern that a shingles outbreak follows. Here’s the highly predictable course of events, which lasts from three to five weeks:

• Day 1: You experience the sensation of burning, tingling, numbness, itching, or sensitivity in a patch of skin. Some people also have flulike symptoms such as fatigue, headache, fever, or upset stomach.

• Day 2 to 5: You develop an angry, painful rash made up of small red spots will appear at the same site. The rash will not cross the mid-line of your body.

• Day 5 to 7: After a few more days, the rash turns into fluid-filled blisters that weep or ooze.

• Day 14 to 20: The blisters dry up and crust over.

• About a month after infection: The scabs clear up.

What’s the Best Treatment for Shingles?

You’re going to want to get yourself to your doctor at the first sensation of discomfort, and certainly the first sign of the rash. That’s because treatment is most effective if it’s started as soon as possible. You can expect to take at least one and possibly several prescription medications. There are also over-the-counter therapies you can try to help ease the discomfort of shingles while the illness runs its course.

Medications

Antiviral drugs are the first line treatment for shingles to treat and shorten the length and severity of the illness, but timing is of the essence: They need to be started within 72 hours of the rash appearing to do their job well. After that point, an antiviral may still help if new blisters are continuing to appear. And although there is no cure for shingles, these drugs can help the blisters dry up faster, limit your pain during the illness, and lessen the chances that you will develop PHN.

Antivirals are usually taken orally for a week and there are three possible options in this category:

• Zovirax (acyclovir): This was the first antiviral approved to treat shingles and is the least expensive option. It works by lowering the ability of the virus to multiply, thereby reducing your symptoms. Unfortunately, acyclovir needs to be taken five times a day, which can be a challenging schedule for many people.

• Valtrex (valacyclovir): This med is very similar to acyclovir, but with two big improvements. First, valacyclovir is better absorbed by the body so it only needs to be taken a more manageable three times a day. Studies have also found that valacyclovir works faster than acyclovir in reducing pain. As a result, it has become the most commonly prescribed antiviral for shingles treatment.

• Famvir (famciclovir): This medication is equivalent to valacyclovir in effectiveness and also only needs to be taken three times a day.

Side effects you may experience with these antivirals include headache, nausea, vomiting, and stomach pain, although none of these are all that common. All three are considered very safe and are generally well-tolerated.

Two other prescription medications may be included in your treatment, particularly if your rash appears worse or more aggressive than average, which could mean you’re at greater risk of developing PHN. No one really knows why some shingles patients develop PHN and others don’t, but doctors often try to reduce those odds with more aggressive treatment. The meds you could be given in addition to your antiviral prescription are:

• Deltasone (prednisone): This corticosteroid is an oral prescription drug that can help ease the discomfort, inflammation, pain, redness, and itching of the rash and blisters. Because steroids can have significant side effects, such as high blood pressure and weakened bones, they should never be taken long-term (more than three months) despite their effectiveness.

• Neurontin (gabapentin): Gabapentin is known as an anticonvulsant, a medication that’s typically used to prevent and control seizures. It’s very effective for the pain of shingles because both seizures and shingles pain involve the abnormally increased firing of nerve cells. Gabapentin is taken orally; the most common side effects are drowsiness and dizziness.

Supportive Treatments

While you’re waiting for the prescription meds to do their job, other remedies may help to ease your discomfort. Here are a few things you can try:

• Aluminum acetate solution. This OTC remedy (sold as Domeboro or Burow’s) is a natural astringent that speeds the drying of blisters from the rash.

• Calamine lotion can be used to relieve itching once your blisters have scabbed over.

• Cold water compresses. During the initial rash and while your blisters are still in the weeping stage, soak a soft cloth in ice water and then apply it directly onto the rash to help ease pain and speed drying of the blisters.

• Cool baths. Soak in the tub with colloidal oatmeal or baking soda to help relieve itching.

• Loose-fitting clothing. Tight jeans are not your friend during shingles. Soft, natural fibers that don’t put pressure on your skin will be most comfortable.

• Over-the-counter pain relievers. Options such as acetaminophen and nonsteroidal anti-inflammatories (NSAIDS) such as ibuprofen can reduce pain. (Prescription pain medications may be given in more severe cases.)

• Petroleum jelly or Aquaphor ointment. Cover the rash with a thin layer of either lube, then apply a non-stick bandage so you avoid touching (and spreading) it.

• Silvadene cream or Mupirocin ointment. These prescription topical antibiotics can be applied after the blisters stop weeping to prevent infection.

Treatment for PHN

If you are one of the 20% of people who develop this serious complication from shingles, your doc may prescribe you the anti-seizure medication gabapentin (if you aren’t already taking it). Low doses of certain antidepressants, including Effexor XR (venlafaxine) and Cymbalta (duloxetine) have also been shown to help because they affect how your body interprets pain.

Skin patches that contain either pain-relieving lidocaine or capsaicin, an extract of chili peppers, can also be applied to ease skin pain. Severe cases may require prescription pain relievers, but these are usually only given as a last resort because of their addictive potential.

There is no easy solution for PHN, which can last months or years, although these treatments may lessen the severity of it. That’s why the most important thing you can do to keep yourself healthy and pain-free is to get the shingles vaccine. Think about it: If you are over 50, you have a one in three chance of getting shingles. That’s like saying between your partner, sibling, and yourself, one of you will get the virus. With the vaccine, there less than a 3% chance that any of you will get sick. So what are you waiting for?

Meet Our Writer

Stephanie Wood

Stephanie Wood is a award-winning freelance writer and former magazine editor specializing in health, nutrition, wellness, and parenting.

How To Treat Shingles – Shingles Treatment Ointment

What does Shingles Look like?

Shingles’ main characteristic is a red, blistering rash that is accompanied by shooting, burning, and/or tingling pain. It typically manifests on one side of the torso, but the rash can form anywhere, including the face. The blisters are usually small and form a single, large stripe across the body. Shingles may be confused with other skin conditions, such as eczema and hives, but the pain is much more severe with a shingles rash. A good topical ointment for shingles may help to alleviate some symptoms. If you have shingles, you may also experience fever, chills, and headache.

What is Shingles?

Shingles is a painful rash that one in three adults develop later in their lives. It may sound like just annoying skin ailment, but this is a virus that actually originates in your nerves. The virus that causes shingles starts off in your nerve cells, and the blisters tend to form over the nerves in your torso, which is what causes such intense pain. Sufferers of the condition often wonder what is the best cream to put on shingles, in order to lessen the pain.

How Long does Shingles last?

Typically, the shingles rash lasts two to five weeks. You may start to feel pain and/or tingling before the rash shows up. A few days after the red rash appears, the skin starts to blister. After a week or so, the blisters start to scab over, and then slowly start to clear up. The exact duration of the rash is different for each person, but two to five weeks is the average span of the virus. However, because shingles affects the nerves, some people may experience lingering pain even after the rash clears, a condition known as post-herpetic neuralgia (PHN). PHN can be monitored and alleviated by your doctor, and does often lessen over time, but it can extend the experience of shingles. Additionally, a doctor can also advise on what cream is good for shingles, helping one cope with the discomfort.

What Causes Shingles?

The shingles rash is caused by the same virus that causes the chickenpox rash. While chickenpox is commonly seen in children, shingles is more common in adults, especially those who are over fifty. The reason why the chickenpox virus reactivates after so long is still a mystery. In fact, not every person who had chickenpox will develop shingles. However, because those who are older, have immune system deficiencies, are undergoing chemotherapy, or are taking immunosuppressant drugs (for organ transplants or autoimmune diseases) are at higher risk for developing shingles, it’s possible that a weakening of your immune system heightens your risk for shingles.

How do You Get Shingles?

If you had chickenpox as a child, you actually already have the same virus that could eventually cause shingles. Even once your chickenpox clears and you are no longer contagious, the virus lies dormant in your cells. However, while chickenpox can easily spread from one person to another, the shingles virus works differently. Shingles is contagious only to people who haven’t had chickenpox or the chickenpox vaccine, and can spread chickenpox to those people. Then, once those people have the chickenpox virus introduced into their systems, they are at risk for developing shingles themselves.

How to Treat Shingles?

If you suspect you have shingles, see your doctor as soon as possible. Your doctor can confirm the diagnosis and prescribe a shingles cream to help you shorten the rash and feel better faster. Some doctors will recommend the use of antiviral medications. Unlike other medications, EMUAID^® ointment can penetrate deep into the skin and kill infectious bacteria and fungi, making it a suitable ointment for shingles. Possessing potent healing properties, EMUAID^® also helps to reduce inflammation, pain, and itching.

Using EMUAID

^® for Relief of Shingles.

Shingles is a painful rash in the form of blisters forming over the nerves in a person’s body. It is a common ailment, affecting one in three adults in their lives. EMUAID^® is effective in relieving the symptoms of shingles and provides relief on contact. The numerous positive EMUAID^® reviews are a testament to its effectiveness in combating the symptoms of shingles.

The World’s Most Versatile Treatment For Over 100+ Resistant Skin Conditions

Did you know that EMUAID^® First Aid Ointments can help to treat other 100+ challenging to treat skin conditions? EMUAID^® and EMUAIDMAX^® First Aid Ointments have helped many customers with relieving symptoms of many resistant skin conditions, such as cellulitis, neuropathy, psoriasis and others. Read many of our happy customers’ stories about how EMUAID^® has changed their lives at the customer review section on our website.

Dermatologists Share Tips for Treating Shingles

Newswise — SCHAUMBURG, Ill. (March 10, 2015) – If you have ever had chickenpox, or been vaccinated for it, you are at risk for getting shingles – a painful, blistering rash. This is because after the chickenpox clears, the virus stays in the body. If the virus reactivates, or wakes up, you could get shingles.

“Although shingles is much less contagious and itchy than chickenpox, it tends to cause more pain,” said board-certified dermatologist Daniela Kroshinsky, MD, MPH, FAAD, assistant professor of dermatology, Harvard Medical School. “In addition, although the shingles rash usually clears in a few weeks, some people can experience pain, numbness, itching and tingling that can last months or even years.”

According to dermatologists from the American Academy of Dermatology (Academy), common signs and symptoms of shingles include:

• –     An area of skin that burns, itches, tingles or feels very sensitive: This usually occurs in a small area on one side of the body and lasts one to three days.
• –     A rash that begins as red spots and quickly turns into groups of clear, painful blisters: These may turn yellow or bloody before they scab over and heal.
• –     Flu-like symptoms: A fever or headache may occur with the rash.
• –     Pain: Sometimes, the pain is bad enough for a doctor to prescribe medication. The pain tends to lessen once the blisters heal, which can take two to three weeks.

To help relieve shingles pain and discomfort, the Academy recommends the following tips:

• 1.     See a board-certified dermatologist as soon as symptoms appear. A dermatologist may prescribe anti-viral medicine and a medicine to help reduce the pain more quickly. When used within 72 hours of the rash appearing, these medications may make symptoms milder and shorter.
• 2.     Cool the rash with ice packs, cool wet cloths, or cool baths.
• 3.     Gently apply calamine lotion to the rash and blisters. Never pick at, scratch or pop the blisters, as the fluid within the blisters can be contagious and blisters help your skin heal.
• 4.     Cover the rash with loose, non-stick, sterile bandages.
• 5.     Wear loose, cotton clothing around the body parts that hurt.

“If you suspect you have shingles, avoid contact with women who are pregnant and anyone who has not had chickenpox or has not been vaccinated, and see a board-certified dermatologist right away,” said Dr. Kroshinsky.

According to the Centers for Disease Control and Prevention, nearly one million Americans experience shingles each year, and the disease is most common in older adults. A vaccine, which can help prevent shingles, is available to people ages 50 and older, and it is recommended by dermatologists.

These tips are demonstrated in “Shingles: Pain Management,” a video posted to the Academy website and the Academy’s YouTube channel. This video is part of the Dermatology A to Z: Video Series, which offers relatable videos that demonstrate tips people can use to properly care for their skin, hair and nails. A new video in the series posts to the Academy’s website and YouTube channel each month.

# # #

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 18,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology), Twitter (@AADskin), or YouTube (AcademyofDermatology).

The Stages of Shingles and How the Condition Progresses

• The stages of shingles are tingling pain, followed by a burning feeling and a red rash, then blistering, and finally the blisters will crust over.
• You will typically develop a rash about 1-5 days after you feel numbness or tingling pain.
• During the blistering phase, you are contagious and can spread chickenpox if someone touches your blisters. 
• This article was medically reviewed by Julia Blank, MD, family medicine physician at Providence Saint John’s Health Centre in Santa Monica, California.
• Visit Insider’s Health Reference library for more advice.

Shingles is a painful skin condition caused by the same virus as chickenpox. It most often affects people over 50 years old, and outbreaks usually last for 3 to 5 weeks. 

There are four different stages of shingles, including a skin-blistering phase during which you can spread the disease to other people. Here’s what you need to know about the different stages of shingles and the best way to treat and prevent this disease.

What is shingles?

If you have ever had chickenpox, an itchy skin rash caused by the varicella-zoster virus, you are at risk of developing shingles. Because after you heal from chickenpox, the virus stays in your body and hibernates inside of your nerve cells.

The virus is kept in check by your immune system but, “as you get older and your immune system is weaker, you can break out in shingles in a localized region of your body,” says Brian Kim, MD, a dermatology professor at the Washington University School of Medicine. 

About one in three adults will get shingles. A shingles outbreak can take weeks to heal, and the illness tends to follow a similar pattern, moving through several phases before becoming dormant again. Here is an overview of each stage of a shingles outbreak.

1. Tingling pain or numbness

During the first stage of shingles, before anything appears on your skin, a particular area of your body may begin to feel different. “When a shingles outbreak is starting, you may feel itching, burning, or pain,” Kim says. Often you will feel this on only one side of your body.

The initial signs of shingles may feel different for each person. In some cases, shingles can cause intense sensitivity, making it painful to even wear clothes over your skin, while in other cases, your skin may feel numb. 

2. Burning feeling and red rash

Between 1 and 5 days after you start to feel the tingling or numb feeling, a red rash will develop on the same area of your skin. Most often, the rash appears on one side of your torso, but it can show up anywhere on your body. 

You may also have other symptoms along with the rash, such as: 

• Headache 
• Fever
• Upset stomach

When the rash starts, you should see a doctor for treatment as soon as possible. Starting antiviral medication treatment within 3 days of the rash first appearing can lower your risk of developing complications, like long-term pain.

3. Blistering

A few days after the rash appears, it will start to form painful blisters filled with fluid. These blisters can break open and leak fluid that contains infectious amounts  of the varicella-zoster virus. 

If someone who has not had chickenpox touches this fluid, the virus can infect them and cause a case of chickenpox. However, anyone who has already had chickenpox or the chickenpox or shingles vaccine will not be at risk of catching the virus from you. 

Though it is possible, shingles is generally not transmitted from person to person,” Kim says. 

“Fortunately, most people have had chickenpox in childhood or are vaccinated now so this is very rare,” Kim says. 

4. Blisters crust over

About 7 to 10 days after the blisters appear on your skin, they will begin to dry up. The leaked fluid will form a crust over the rash and your sores will no longer be open. 

“You will stop being contagious after the blisters have crusted over,” Kim says.

Once the blisters have crusted over, your skin will gradually heal and the scabs will disappear over the next couple weeks.

How to treat and prevent shingles

Shingles is treated using antiviral medications, such as:  

• Acyclovir (Zovirax) 
• Valacyclovir (Valtrex). 

To manage shingles pain, you can also use numbing creams like lidocaine, or place a cool, wet washcloth on your skin.

It’s important to get treatment as quickly as possible because, “people with shingles can develop long-term pain or itch after the shingles resolves if the virus does too much damage,” Kim says.

To stop yourself from spreading varicella-zoster to anyone else, try to cover up your rash when possible and avoid directly touching it.

The best way to prevent shingles is to get a shingles vaccine. The newest vaccine, called Shingrix, is 85% to 90% effective at preventing shingles in people who have already had chickenpox. If you have never had chickenpox, you will need to get the chickenpox vaccine instead.

The bottom line

Shingles is a common condition that can cause extreme pain if it isn’t properly treated. If you develop a rash that you think may be shingles, see your doctor as quickly as possible to get treatment and prevent any serious complications.

Herpes zoster (shingles) | Memorial Sloan Kettering Cancer Center

This information tells about herpes zoster (shingles), including how it spreads and how to treat it.

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What is herpes zoster?

Herpes zoster, also called herpes zoster, is an infectious disease caused by the varicella-zoster virus. This is the same virus that causes chickenpox.Herpes zoster occurs only in those individuals who have previously had chickenpox. When the chickenpox is gone, the chickenpox virus remains inactive in the body. This means that you may not feel symptoms, but the virus is still present in your body. When the varicella-zoster virus becomes active again, it causes herpes zoster.

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What are the symptoms of herpes zoster?

People with herpes zoster develop a rash similar to the chickenpox rash.It can cause itching, burning, and pain.

In localized herpes zoster, the rash usually appears as a wide band on one side of the body. With disseminated (more widespread) herpes zoster, the rash covers a larger area of ​​the body.

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How is herpes zoster spread?

Herpes zoster can be spread by touching an infected person’s blisters. Disseminated herpes zoster can spread through contact with droplets of liquid from the nose and throat of an infected person.Droplets containing the virus are released into the air when an infected person coughs or sneezes. They are easy to breathe in and get infected.

If you have had chickenpox before, your virus will not become active as a result of contact with a person who has herpes zoster. However, if you have not had chickenpox, you may get it after contact with someone who has herpes zoster.

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Who is at risk of contracting herpes zoster?

Herpes zoster usually develops in people with serious medical conditions or weak immune systems.

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How is herpes zoster treated?

For the treatment of herpes zoster, antiviral drugs, skin creams and, if necessary, pain relievers are used.

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What precautions are taken in the hospital if I have herpes zoster?

Isolation measures are activities we take to prevent the spread of infection among patients.If you were diagnosed with chickenpox during your hospital stay or at risk of contracting the disease:

• You will be placed in a separate room.
• The door to your room must always be closed.
• A sign will be posted on your door informing all staff and visitors to wash their hands with soap and water or rub them with alcohol-based hand sanitizer before entering and after leaving your room.
• Isolation measures for localized and disseminated herpes zoster are different.
  • For localized herpes zoster, all visitors and staff should wear a yellow gown and gloves while in your room. They are issued outside of your room and can be disposed of in your room.
  • For disseminated herpes zoster, visitors and staff should wear a yellow gown, gloves, and respiratory mask when in your room.
    • Subject to these isolation measures, you are prohibited from walking in the ward.
• For any type of herpes zoster, you are not allowed to walk around the ward or access the following areas of the hospital:
  • pantry for groceries in your department;
  • recreation center at M15;
  • children’s recreation areas in the M9;
  • cafeteria;
  • main lobby;
  • any other common areas of the hospital.
• You may have art therapy or massage sessions in your room.
• You should wear a yellow coat and gloves when leaving your room for diagnostic tests. If you have disseminated herpes zoster, you will also need to wear a mask.

You can stop following these precautions when all the blisters are dry and crusty.

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What are the ways to prevent herpes zoster?

For the prevention of herpes zoster, the Zostavax ^® vaccine is used.This vaccine is recommended for people over 60 years of age, but should not be used if the immune system is weakened. Your doctor can provide more information about this vaccine.

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Where can I get more information about herpes zoster?

If you have questions, talk to your doctor or nurse. Alternatively, for more information, you can visit the websites:

Center for Disease Control and Prevention

www.cdc.gov/shingles/hcp/clinical-overview.html

NYS Department of Health

www.health.ny.gov/diseases/communicable/shingles/fact_sheet.htm

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Shingles (Herpes zoster)

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests.For a diagnosis and correct treatment, you should contact your doctor.

Shingles (Herpes zoster): causes, symptoms, diagnosis and treatment.

Shingles is an infectious disease, the causative agent of which (herpes virus type 3) also causes chickenpox.

Since the virus, penetrating the sensitive nerve endings, is embedded in the genetic apparatus of nerve cells, it is impossible to remove it from the body.In those who have had chickenpox, the virus goes into a latent (inactive) state.

With a weakening of immunity, the virus is activated, affecting the skin. The disease develops more often in the elderly and in persons with immunodeficiency states.

Causes of the disease

The virus is transmitted from a patient with chickenpox or shingles by contact or airborne droplets. A person who becomes infected at the same time (most often a child) develops chickenpox.Penetrating through the mucous membranes into the blood and lymph, the virus reaches the nerve cells, where it begins to multiply. After recovery, the virus remains in the body for life, often being in an inactive state. The awakening of the infection is associated with a weakening of immunity caused by hypothermia, prolonged use of steroid hormonal drugs, immunosuppression (after transplantation), chemotherapy and radiation therapy, as well as a general decrease in immunity in patients with blood diseases, cancer and viral diseases.Shingles is very difficult in HIV-infected patients.

Classification of herpes zoster

The clinical picture of herpes zoster consists of cutaneous manifestations and neurological disorders. Distinguish between typical and atypical forms of the disease. In the atypical form, the course of the disease may be erased, in which papules develop in the foci of hyperemia, which do not transform into vesicles.

With herpes zoster, the spread of the pathological process corresponds to a certain area of ​​the skin and does not cross the anatomical midline of the trunk.In most patients, the appearance of a rash is preceded by a burning or itching sensation in a specific area of ​​the skin, as well as pain that can be stabbing, throbbing, shooting, paroxysmal, or persistent. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, headache.

Infection of the central nervous system and damage to the meninges can give meningeal, encephalic (symptoms indicate a virus infection of the brain and / or spinal cord and meninges) or mixed forms of herpes zoster.If the infection spreads along the optic nerve, ophthalmic herpes develops.

When a rash appears over the entire surface of the skin and on parenchymal organs (eg, liver, kidneys), a generalized form of shingles develops. Another type of shingles is hemorrhagic. The characteristic feature is a bloody fluid within the vesicles.

Symptoms of herpes zoster

The onset of the disease is accompanied by general intoxication, malaise and fever.Nausea and vomiting are possible. The lymph nodes are enlarged.

There are pronounced pains along the affected nerve, which may be constant, but more often have a paroxysmal itching character, intensifying at night.

As a rule, they are provoked by any irritants: touching the skin, cold, movement. Some patients complain of loss of sensitivity in certain areas of the skin, which can be combined with increased pain response. Sometimes pain syndrome in the absence of skin rashes can resemble angina pectoris, myocardial infarction, renal colic or pancreatitis.The period of neuralgia preceding the rash lasts up to 7 days. Then nodules appear on one side of the body, from which bubbles form with a transparent content, which gradually becomes cloudy. After 3-7 days, most of the bubbles dry up with the formation of yellow-brown crusts. When the vesicles are injured, bright red sores are exposed. After the sores have healed, small scabs or scars remain on the skin.

Most often, rash and pain are noted in the region of the ribs, lower back and sacrum, less often – along the branches of the trigeminal, facial and ear nerves and on the limbs.

In rare cases, mucous membranes are affected.

Shingles Diagnosis

The diagnosis can be made after examining and interviewing the patient. The doctor pays attention to the nature of the rash (localized and one-sided), the type of blisters and complaints of itching, burning pain. It is more difficult to identify an atypical form of herpes zoster. With an erased form, pain and other neurological symptoms may be absent. With neurogenic disorders before the appearance of rashes, the diagnosis can be made based on the results of laboratory tests.In this case, a histological examination is used, and the virus is also isolated in cell culture. The Tsank test helps to quickly confirm the herpetic nature of the rash: giant multinucleated cells are found in scraping material taken from the base of the vesicle. However, this test does not provide an opportunity to determine the type of herpes. Methods of enzyme-linked immunosorbent assay and indirect immunofluorescent reaction are also used. Recently, the diagnosis of viral infections is carried out using the polymerase chain reaction (PCR).

Which doctors should you contact

Depending on the primary symptoms, patients with herpes zoster may refer to different specialists. However, first of all it is worth going to
a therapist for examination and receiving referrals for tests. With the appearance of limited, localized skin rashes and the absence of pain symptoms, it is necessary to consult a dermatologist for a differential diagnosis of erysipelas (caused by bacteria), eczema, etc.In case of severe pain syndrome, movement disorders, consultation is required
neurologist. In case of eye damage, pain when moving the eyeballs, an ophthalmologist’s consultation is required. The generalized form of herpes often requires hospitalization and the combined efforts of an immunologist, neurologist and dermatologist.

Treatment for shingles

For any localization of rashes, antiviral agents are first of all prescribed (the drug, the frequency of administration and the dosage is determined by the attending physician!).

Their action is especially effective in the first 72 hours from the onset of clinical manifestations.

If you have severe pain, your doctor may recommend anti-inflammatory therapy. However, it is necessary to take into account contraindications (for example, chronic diseases such as arterial hypertension, diabetes mellitus, erosive intestinal lesions, gastric ulcer and duodenal ulcer). If analgesics are not effective, doctors may prescribe drugs with central analgesics (often prescription drugs) and neural blocks.Topical (topical) treatment is necessary to eliminate inflammation and prevent other agents (such as bacteria) from contracting the skin. With erosive forms of herpes zoster, creams and ointments that have an antibacterial effect are applied to the affected areas.

The doctor may also recommend treatment aimed at increasing immunity, for example, taking vitamins (in particular, group B).

Complications

When the vesicles are opened, a secondary infection (bacterial infection of the skin) is possible, which is accompanied by an increase in temperature and general intoxication.

Typical complications of shingles include neuritis, paresis and paralysis of the sensory and motor nerves.

Postherpetic neuralgia is difficult to treat.

The ocular form of herpes can lead to keratitis (inflammation of the cornea), less often to iritis (inflammation of the iris of the eye) or glaucoma (increased intraocular pressure). In addition, it is possible to develop optic neuritis, sometimes with its subsequent atrophy and blindness.When the branch of the oculomotor nerve is damaged, ptosis (drooping of the upper eyelid) develops. Sometimes patients complain of hearing impairment, damage to the vestibular apparatus, in severe cases – of paralysis and paresis of the oral cavity organs. In addition, patients may experience tinnitus or increased sensitivity to sounds. The defeat of the lumbosacral ganglia sometimes leads to urinary retention, constipation, or diarrhea. In patients with significantly weakened immunity (with HIV infection, cancer), shingles often occurs in a generalized form and is complicated by meningitis, encephalitis or meningoencephalitis.

Prevention of shingles

Since shingles causes the same pathogen as chickenpox, the prevention of the disease will be based on the same measures as for chickenpox.

To prevent the spread of infection, isolation of the patient is necessary, which lasts up to 5 days from the moment the last element of the rash appears.

Persons who have been in contact with a patient with chickenpox are monitored for 21 days. As an emergency prophylaxis, active (vaccination) and passive (immunoglobulin administration) immunization are used.Vaccination is carried out for children over 12 months old and adults who have no contraindications, in the first 72-96 hours after probable contact with a patient with chickenpox or shingles. Passive immunization with anti-chickenpox immunoglobulin is indicated for persons with low immunity, who have contraindications to vaccinations, pregnant women, children under 12 months of age and newborns whose mothers fell ill with chickenpox within 5 days before the birth of the child. The introduction of immunoglobulin is also carried out within 72-96 hours after contact with a patient with chickenpox or shingles.

References

1. Herpes zoster: Clinical guidelines. Ministry of Health of the Russian Federation. 2016.
2. Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 05.02.2018 No. 12 on the approval of SP 3.1.3525-18 “Prevention of chickenpox and shingles.” 2018.

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests.For a diagnosis and correct treatment, you should contact your doctor.

Information checked by expert

Lishova Ekaterina Alexandrovna

Higher medical education, work experience – 19 years

90,000 Modern approaches to the complex therapy of herpes simplex and shingles

Viral diseases of the skin and mucous membranes (blistering fever, shingles) are common on all continents, and in recent years there has been an upward trend.For viral diseases, chronic relapsing course, frequent complications, transition to a latent state, and difficulties in therapy are typical. The causative agent of blistering fever is the filtering herpes simplex virus (HSV) type 1, which belongs to the Herpetoviridae family, genus Herpesvirus. Currently, about 95% of the world’s population is infected with HSV type 1; only 10–20% of them have visible clinical manifestations, and the rest of the HSV is in a latent state in the nerve ganglia.According to statistics, cases of herpes zoster (herpes zoster, zona), the incidence of which is observed in the autumn and spring periods of the year, began to be recorded more often. The causative agent is a virus – virus varicella zoster (abbreviated VZ). Shingles occurs in elderly people (over 50-55 years old) with severe chronic diseases (diseases of the blood and hematopoietic organs, malignant neoplasms, HIV-infected), as well as in people taking drugs with immunosuppressive effects (glucocorticosteroid hormones, cytostatics, etc.).).

A viral infection is transmitted by close contact with asymptomatic individuals who shed the virus (virus carriers). Infection occurs by inoculating the virus through the lips, skin, mucous membranes, genitals, and conjunctiva. The greatest danger is posed by patients during a relapse of the disease, during the period of blistering rashes, as well as virus carriers. Having penetrated through the skin or mucous membranes during the primary infection, which may be accompanied by symptoms or be asymptomatic, the virus enters the sensitive or autonomous ganglia along the peripheral nerves, where a latent infection occurs.Relapse, as a rule, is due to reactivation of the virus, causes herpetic eruptions, and quite often there is a severe long course. A viral infection can affect the skin and mucous membranes, the central nervous system (encephalitis, meningoencephalitis, encephalomyelitis), eyes (keratitis, conjunctivitis, uveitis), liver (hepatitis), genitals.

Clinic

Herpes simplex, blistering fever, “fever”, blistering lichen simplex

Many patients have vesicular or ulcerative lesions.In recent years, there has been an increasing number of patients with atypical lesions (cracks, erosion, tongue, minor ulceration). Symptoms appear on average 5-7 days after infection. Subjective sensations (itching, burning, soreness) accompanying the rash are the result of an infectious inflammation of the nerves. On the erythematous-edematous background of the skin and mucous membranes, there are multiple or single, painful vesicles up to 1-3 mm in diameter with transparent or serous contents, which then becomes cloudy.On average, after 3-5 days, the bubbles dry up with the formation of yellow crusts or open, and small pink-red erosion appears. Often, the vesicles merge and a multi-chambered bubble with finely festooned outlines is formed, which can be opened, a pink-red painful erosion appears. Crusts then form, which later fall off and leave behind temporary secondary pigmentation. Most often, blister lichen is localized on the face ( herpes facialis ), lips ( herpes labialis ), wings of the nose ( herpes nasalis ), in the genital area ( herpes progenitalts ), less often in the oral cavity ( herpes buccalis) ).Clinical manifestations usually last 2–3 weeks. A number of complications can be observed: the addition of a secondary infection, reinfection of the skin and mucous membranes with the released virus, neurological manifestations (aseptic meningitis, transverse myelitis, etc.). Recurrent herpes can occur against the background of a violation of the general condition of patients (malaise, headaches, low-grade fever). Subjective disorders (itching, burning, soreness) are more common. A number of patients have long-term neuralgia.Primary or recurrent herpes in immunosuppressed patients is accompanied by more intense ulceration of the skin and mucous membranes than in patients with normal immune systems, and HSV can disseminate to many organs. In pregnant women, with the primary manifestations of the disease, fetal infection may occur (delayed development, premature birth). Often in newborns, the skin, mucous membranes of the eyes and mouth are affected. Rare complications are encephalitis, damage to internal organs.Clinical manifestations of infection occur at 2–3 weeks of life (vesicular skin rash). The transmission of HSV to a child can occur intrauterinely or transplacentally, when passing through the birth canal of the mother, after childbirth, in contact with sick persons. The greatest number of diseases in newborns occurs with primary infection in the mother in late pregnancy, which can cause disseminated infection in the newborn.

Shingles (herpes zoster, zona)

Acute onset of the disease is characteristic.General weakness, fever, and neuralgic pains of varying intensity preceding the appearance of a rash are often observed. Against the background of edematous and hyperemic skin, nodules appear, transforming after 3-4 days into tense vesicles with a thick lining and serous contents, which, on average, become cloudy after 3-4 days. On days 5–7, the bubbles shrink into yellowish brown crusts. After 7-10 days, the crusts fall off, leaving temporary pigmentation or depigmentation. A unilateral location of the rash along the nerves and intense painful sensations are typical.Regional lymph nodes are painful, enlarged. Most often, the pathological process is localized on the face in the forehead, head, eyes, back of the head, on the neck, shoulders, chest, abdomen, thighs and buttocks. After the transferred disease, immunity remains. As a rule, relapses are not observed.

Abortive forms of shingles may occur.

Abortive herpes zoster (herpes zoster abortivus) . Revealed hyperemia, swelling of the skin, individual nodules.Subjective sensations are not significantly expressed.

Shingles (herpes zoster bullosus) . Simultaneously with the usual bubbles, bubbles are determined, reaching the size of a pigeon’s egg.

Hemorrhagic shingles (herpes zoster haemorrhagicus) . There are vesicles with hemorrhagic contents, hemorrhagic spots, petechiae.

Gangrenous, or necrotic, herpes zoster (herpes zoster gangraenosus, necroticans) .There are vesicles with a black scab on the surface, when removed, an ulcerative surface is noted. Characterized by a severe long course (2-3 months or more), severe pain, long recovery.

Generalized or disseminated herpes zoster (herpes zoster generalisatus seu disseminatus) . On various parts of the skin and mucous membranes, rashes resembling elements of chickenpox are detected without subjective sensations, which regress after 1-2 weeks.The general condition is disturbed (fever, malaise). Mostly elderly people are ill.

Diagnostics

To detect a viral infection, laboratory diagnostic reactions are mainly used, which are characterized by speed, specificity and high sensitivity. At the same time, many difficulties arise when interpreting the research results, which is associated with the variability of viruses, various clinical manifestations, and asymptomatic course in most patients.According to a number of authors, a diagnosis based only on the clinical picture can identify less than 40% of patients infected with the virus.

Diagnostic methods

Isolation of HSV in cell culture is the gold standard for acute infection, but less indicative at the stage of ulcer and crust formation. Tests for the detection of HSV AG or HSV DNA using PCR, in which the HSV DNA is amplified in the samples. DNA hybridization technique. Serological tests.Biological (reaction of neutralization of antibodies ATPHAT, reaction of complement binding – RSK). Solid phase (reverse passive hemagglutination reaction (ROPGA), enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence reaction). Protein-specific immune tests (in particular, immunodot).

Currently, an urgent problem is the development of new effective methods of treating viral infection, which presents difficulties due to the ability of viruses to persist in the human body, to remain in a latent state for a long time and to be reactivated under the influence of internal and external unfavorable factors [1, 9, 12, 19].It should be noted that the effectiveness of antiviral agents in acute viral infections becomes much higher if they are prescribed earlier (in the prodromal period or on the first day of the disease). The greatest effect is observed when the patients themselves begin the treatment, since in most cases doctors prescribe medications 48 hours later. This approach makes it possible to facilitate the clinical course, prevent the occurrence of severe complications, limit the intake of anti-inflammatory and antibacterial agents, and shorten the cure for patients.

Treatment

In the clinic of skin and venereal diseases of the Donetsk National Medical University named after M. Gorky in the treatment of blistering fever and shingles used the drug Acyclovir Herd (“Nizhpharm”). After the penetration of acyclovir into cells infected with herpes viruses, it is phosphorylated into acyclovir monophosphate with the participation of the enzyme thymidine kinase, which is found in cells infected with the virus. Acyclovir monophosphate is converted to acyclovir triphosphate, which has antiviral activity.Then the activity of the viral polymerase enzyme is inhibited, which leads to inhibition of viral DNA synthesis and, accordingly, to inhibition of viral replication. Acyclovir Herds in primary exacerbation was prescribed 200 mg 5 times a day or 400 mg 3 times a day for 7-10 days. In the treatment of relapses, Acyclovir Herd was used at 200 mg 5 times a day, or 400 mg 3 times a day, or 800 mg 2 times a day for 5 days. Suppressive therapy was prescribed to patients with 6-8 or more exacerbations per year – Acyclovir Herd 200 mg 4 times a day or 400 mg 2 times a day for 3-12 months.

In the complex therapy, the immunocorrecting drug Lavomax was prescribed (inside the first 2 days, 1 tablet (0.125 g) once a day, then 0.125 g once every 2 days (for a course of treatment 2.5 g)), which has the property of inducing the production of interferon 3 types: interferon. The antiviral effect of Lavomax is realized as a result of the interferon-producing effect, which leads to the suppression of the intracellular reproduction of viruses in infected cells and the protection of uninfected ones from the penetration of viruses.The difference from other interferon inducers is the ability of Lavomax to maintain the therapeutic level of interferonemia for a long time (up to 8 weeks after the course of treatment), which contributes to the prevention of relapses. The immunostimulating effect of the drug Lavomax is due to the interferon-inducing effect, which causes the activation of T-lymphocytes, increased antibody production and stimulation of phagocytosis by macrophages.

According to indications, injections of vitamin B were prescribed ₁ . Along the length of the nerve fibers – diadynamics, ultrasound, novocaine blockade of the corresponding area.Ultraviolet irradiation in erythemal doses.

In external therapy, 5% Acyclostad® cream was used, which was applied in a thin layer to the affected skin area 5 times a day every 4 hours for 5-10 days. The required amount of cream is applied to a cotton swab, sufficient to cover the affected skin area. When applying Acyclostad®, it is necessary to ensure that the cream covers not only areas with visible signs of damage (bubbles, swelling, redness), but also adjacent skin areas.If the drug is applied by hand, you should thoroughly wash your hands before and after the procedure to prevent possible additional infection of the affected skin with bacteria or the transfer of viruses to the not yet infected areas of the mucous membrane and skin. To achieve the best effect, Acyclostad® should be used at an early stage, after the first signs of the disease are detected (burning, itching, swelling, redness).

According to clinical observations, the patients tolerated the treatment well; there were no side effects during the treatment.

Conclusions

The results obtained allow us to assert that the complex treatment of vesicular fever and shingles with the use of Acyclovir Stada, Lavomax and topically 5% Acyclostad® cream is effective and affordable, well tolerated, does not cause side effects. After the therapy, there was a recovery (disappearance of subjective sensations, regression of rashes). The widespread use of Acyclovir Stada, Lavomax and topically 5% Acyclostad® cream in the treatment of blistering fever and shingles in outpatient and inpatient conditions in the practice of medical institutions will help to cure patients.

Bibliography

1. Aizyatulov R.F. Viral diseases of the skin and mucous membranes (etiology, pathogenesis, clinical picture, diagnosis, treatment, prevention). – K., 2003 .– 128 p.

2. Aizyatulov R.F. Clinical dermatology (etiology, pathogenesis, clinical picture, diagnosis, treatment): An illustrated guide. – Donetsk: Donetskchina, 2002 .– 432 p.

3. Aizyatulov R.F. Skin diseases in the practice of a doctor (etiology, pathogenesis, clinical picture, diagnosis, treatment): an illustrated guide.- Donetsk: Kashtan, 2006 .– 360 p.

4. Andreychin M.A., Kuryata I.G. Combined therapy of operative herpes // Dermatovenereology, cosmetology, sexopathology. – 2000. – No. 1 (3). – S. 150153.

5. Barinsky I.F., Shubladze A.K., Kasparov A.A., Grebenyuk V.N. Herpes (etiology, diagnosis, treatment). – M .: Medicine, 1986 .– 272 p.

6. Zmeichuk I.Ya., Yushchishin N.I., Semenukha K.V. Viral diseases of the skin and mucous membranes // Dermatovenereology, cosmetology, sexopathology.- 1998. – No. 1. – P. 100106.

7. Skin and Venereal Diseases: A Guide for Physicians: In 4 volumes / Ed. Yu.K. Skripkin. – M .: Medicine, 1996 .– T. 4. – 352 p.

8. Urticaria. Viral dermatoses / Ed. E.V. Sokolovsky. – SPb .: SOTIS, 2000 .– 160 p.

9. Postovit V.A. Infectious Diseases: A Guide. – SPb .: SOTIS, 1997 .– 502 p.

10. Svyatenko T.V., Fedotov V.P. Shingles (features of the clinical course, diagnosis, modern methods of treatment) // Dermatovenereology, cosmetology, sexopathology.- 2000. – No. 1 (3). – S. 6270.

11. Bezold G., Lange M., Pillekamp H., Peter R.U. Varicella zoster viraemia during herpes zoster is not associated with neoplasia // Journal of the Europen academy of dermatology and venerology (JEADV). – 2002. – Vol. 16, No. 4. – P. 357366.

12. Fleming D.T., McQuillan G.M., Johnson R.E. et al. Herpes simlex virus type 2 in the United States, 1976 to 1994 // N. Engl. J. Med. – 1997 .– 337 .– 11051111.

13. Wheeler C.E. Jr.The herpes simplex problem // Jam. Acad. Dermatol. – 1998 .– 18 (1 Part 2). – 163168.

Are pain relievers applied to the skin effective?

Key findings

Diclofenac Emulgel, ketoprofen gel, piroxicam gel and diclofenac patch work well enough for sprains and dislocations. For osteoarthritis of the hand and knee, nonsteroidal anti-inflammatory drugs (NSAIDs), topical diclofenac and toprofen, rubbed into the skin for at least 6-12 weeks, help reduce pain by at least half in a small number of people.For postherpetic neuralgia (pain after shingles), highly concentrated topical capsaicin (derived from chili peppers) can reduce pain by at least half in a small number of people.

Relevance

Pain relievers applied to the skin are called local (local) pain relievers (analgesics). There has been a lot of controversy about whether they work, how and under what conditions accompanied by pain (pain syndromes).

Characteristics of research

We searched the Cochrane Database of Systematic Reviews (Cochrane Library) published up to February 2017 for systematic reviews of topical pain relievers. Reviews evaluated the treatment of short-term (acute, less than three months) or long-term (chronic, more than three months) painful conditions. We tested how well local pain relievers work, how much harm they do, and whether people drop out of research.We also looked at the quality of the evidence.

Main Findings

The most frequently reviewed reviews compared the effects of a local pain reliever with a local placebo. A topical placebo is similar to the active ingredient, but it has no pain relieving properties. The use of a placebo eliminates the effects that the rubbing itself can have with some of these local analgesics.

For sprains and dislocations, several topical analgesic NSAIDs rubbed into the skin can help reduce pain by at least half for about a week in about one in 2-5 people.These medicines are Diclofenac Emulgel, Ketoprofen Gel, Piroxicam Gel, Flector Diclofenac Patch, and another Diclofenac Patch. How the drugs are made (what formulation they have) is important as it determines how well they work.

For osteoarthritis of the hands and knees, NSAID pain relievers, topical diclofenac and topical ketoprofen, rubbed into the skin, help reduce pain by at least half for at least 6-12 weeks in about one in 5-10 people.For postherpetic neuralgia, a single dose of topical, highly concentrated capsaicin can reduce pain by at least half in about 1 in 12 people over a period of 8 to 12 weeks.

There is no strong evidence to support any other topical pain reliever for any other pain syndrome.

Low concentration topical capsaicin caused local side effects (such as itching or rash) in 4 out of 10 people, and side effects caused 1 in 12 people to drop out of the study.Side effects and dropout from the study due to side effects in other cases were rare or did not differ from those with the topical placebo. Serious side effects were rare.

Quality of evidence

The quality of the evidence ranged from high to very low. The main reason for the very low quality of the evidence was the small number of participants in some of the studies, making it impossible (or unsafe) to assess benefits or harms.

Acyclovir cream 5% 5g Hexal / Sandoz available in 92 pharmacies in Moscow and St. Petersburg

Acyclovir cream 5% 5g Hexal / Sandoz

Acyclovir Hexal
Buy Acyclovir Hexal in pharmacies

DOSAGE FORMS
cream for external use 5%

MANUFACTURERS
Salutas Pharma GmbH (Germany)

GROUP
Antiherpetic drugs

COMPOSITION
Active ingredient: Acyclovir.

INTERNATIONAL NON-PATENTED NAME
Acyclovir

SYNONYMS
Atsigerpine, Acyclovir-ophthal, Acyclovir, Acyclovir Belupo, Acyclovir Sandoz, Acyclovir forte, Acyclovir-Akos, Acyclovir-Acri, Acyclostad, Vero-Acyclovir, Vivorax, Virolex, Gervirax, Zerpevir, Lerperaxov, Herpesov , Cycloviral Sediko

PHARMACOLOGICAL EFFECT
Antiviral.Highly selectively affects herpes simplex viruses type 1 and 2, shingles, Epstein-Barr and cytomegalovirus. It easily passes through the corneal epithelium (eye ointment) and creates a therapeutic concentration in the eye fluid. When used topically in the form of a cream, it is not absorbed into the systemic circulation. Penetrates the BBB and the placental barrier, excreted in breast milk. With herpes, it prevents the formation of new elements of the rash, reduces the likelihood of cutaneous dissemination and visceral complications, accelerates the formation of crusts, and reduces pain in the acute phase of herpes zoster.It has an immunostimulating effect.

INDICATIONS FOR USE
Primary and recurrent herpetic lesions of the skin and mucous membranes (including genital herpes), herpetic lesions in patients with immunodeficiency (treatment and prevention), herpes zoster, chicken pox, herpetic keratitis simplex.

CONTRAINDICATIONS
Hypersensitivity, breastfeeding.

SIDE EFFECTS
Headache, fatigue, neurological disorders, shortness of breath, nausea, vomiting, diarrhea, intestinal colic, fever, edema, lymphadenopathy, increased levels of bilirubin, urea, creatinine, transient increase in the activity of liver transaminases in the form of allergic reactions skin rash, itching.With the on / in the introduction – agitation, impaired consciousness, lethargy, tremors, convulsions, hallucinations, psychosis, coma; reactions at the intravenous injection site – local inflammation, phlebitis. When applied externally – erythema, peeling, burning sensation, burns.

INTERACTION
Probenecid slows down excretion (blocks tubular secretion).

DOSAGE AND APPLICATION
In case of infection of the skin and mucous membranes caused by the herpes simplex virus, cream or ointment (5%) is applied to the affected surface 5 times a day for 5-10 days.

OVERDOSE
Symptoms: headache, neurological disorders, shortness of breath, nausea, vomiting, diarrhea, renal failure, lethargy, convulsions, coma. Treatment: maintenance of vital functions, hemodialysis.

SPECIAL INSTRUCTIONS
Restrictions on use: Pregnancy. To prevent crystallization in the tubular apparatus, it is recommended to take a large amount of liquid. Caution should be exercised in patients with psychoneurotic disorders, impaired renal and liver function, electrolyte disturbances, severe hypoxia.It is recommended to apply the cream with rubber gloves in order to prevent infection of other skin areas. For more information, see the instructions for use.

STORAGE CONDITIONS
In a dry place, at a temperature not exceeding 25 ° C.

Acyclovir sandoz cream 5% 2g No. 1

Herpes cream

Cream Payayor – Herpes cream based on the tropical plant Clinacanthus Nutans (Burm.f) Lindau (Clinacanthus nutans). The effectiveness of herpes cream Abhai Cream Payayor is many times superior to all existing chemical analogues. Clinacanthus drooping – Clinacanthus Nutans is a rare tropical plant of the Acanthus family. A tall herbaceous plant, sometimes branching in the form of a shrub. It has long, pointed at the ends, lanceolate leaves, numerous red flowers, collected in inflorescences. Distributed in the south of China, in Indochina. Cultivated in Thailand, Vietnam, Java.All parts of the plant are used as medicinal raw materials, but to a greater extent the leaves. On the basis of Clinacanthus, ointments, sprays, balms, aerosols, cosmetic products for external use are made. Clinacanthus can be taken orally in the form of tea, decoctions, encapsulated preparations. Application of Clinacanthus Nutans in oriental folk medicine Clinacanthus is used to get rid of various skin diseases: inflammatory processes, allergic manifestations, eczema, shingles, psoriasis.Due to its high antibacterial properties, the plant is used in cosmetology to restore skin health. Cosmetics with the addition of Clinacanthus relieve irritation, relieve allergic rashes, skin rashes, and reduce skin inflammation. Clinacanthus Nutans cleanses wounds and promotes faster healing. The plant extract heals herpes on the lips and herpes on the body, prevents inflammation of a bacterial and viral nature.
Bactericidal creams and lotions from Clinacanthus help with skin burning, irritation, acne, boils.Relieve swelling and inflammation after insect bites. Balms and ointments from the plant are highly active against the herpes virus. Two glycoglycerolipids with antiviral properties have been isolated from its leaves. These components block the development of the herpes virus in the body, prevent the penetration of viral particles into cells. The balm containing natural plant extract for the treatment of herpes zoster, herpes on the body on the extract of Clinacanthus Nutans reduces the external manifestations of herpes infection in the form of bubbles and helps to quickly cure herpes on the lips and on the body.The high antiviral activity of the plant allows the use of balsams from Clinacanthus for the treatment and prevention of influenza and ARVI. It is allowed in the treatment of herpes in children, during pregnancy, since the drug consists only of a plant extract on glycerin.